title: Lung cancer stigma, anxiety, depression and symptom severity.
abstract: OBJECTIVE
  Compared to other cancers, lung cancer patients report the highest levels of psychological distress and stigma. Few studies have examined the relationship between lung cancer stigma (LCS) and symptom burden. This study was designed to investigate the relationship between LCS, anxiety, depression and physical symptom severity.
  
  
  METHODS
  This study employed a cross-sectional, correlational design to recruit patients online from lung cancer websites. LCS, anxiety, depression and physical symptoms were measured by patient self-report using validated scales via the Internet. Hierarchical multiple regression was performed to investigate the individual contributions of LCS, anxiety and depression to symptom severity.
  
  
  RESULTS
  Patients had a mean age of 57 years; 93% were Caucasian, 79% were current or former smokers, and 74% were female. There were strong positive relationships between LCS and anxiety (r = 0.413, p < 0.001), depression (r = 0.559, p < 0.001) and total lung cancer symptom severity (r = 0.483, p < 0.001). Although its contribution was small, LCS provided a unique and significant explanation of the variance in symptom severity beyond that of age, anxiety and depression, by 1.3% (p < 0.05).
  
  
  CONCLUSIONS
  Because LCS is associated with psychosocial and physical health outcomes, research is needed to develop interventions to assist patients to manage LCS and to enhance their ability to communicate effectively with clinicians.
authors.affiliation: Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, CA 94143, USA. Janine.Cataldo@nursing.ucsf.edu
authors.forename: Janine K
authors.initials: JK
authors.lastname: Cataldo
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Brodsky
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012720:Severity of Illness Index; D057545:Social Stigma; D055815:Young Adult